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Chemotherapy causes side effects because they're potent drugs that block cells that are replicating
or dividing.
Cancer cells are often the ones that are moving most quickly.
And other normal cells like your hair cells, the lining of your mouth or your gut are also
ones that are replicating quickly.
When chemotherapy is given it affects all of those cells; it's trying to hit cells that
are actively dividing.
And there's some spill over, although we think that we can get mainly cancer cells with chemotherapy
sometimes we'll have off target effects on those other sensitive cells.
Most people are very fearful of starting chemotherapy often because they've been touched by cancer
at some point in their lives.
They had the neighbor or the aunt or had to undergo chemotherapy 20 or 30 years ago and
were in these, the people and the memories that they have are of people totally incapacitated
by their chemotherapy.
We've come so far and in recent years we understand how to give good targeted medications that
reduce nausea.
We're able to give drugs that are much less sedating.
Often patients are able to get chemotherapy and continue to attend to their daily tasks.
Often they can go to work within a day or two.
They're able to take care of their families and lead really full lives.
I think it's hard when you've had some sort of history to begin your cancer journey that
you recognize that truly we've come to a new chapter for many people.
And chemotherapy can be much more tolerable.
Chemotherapy drugs cause a myriad of side effects.
And I think that's important when a patient or caregiver first meets a doctor.
Your story of side effects that a friend of yours might have had when experiencing chemotherapy
for colon cancer might be very different than the side-effects you might experience if you
have a lymphoma.
So we know that there are side effects like lowering of blood counts that are common to
many chemotherapy drugs, some chemotherapy drugs cause people to lose hair, others don't.
Some cause damage to nerves and others don't.
Some can cause diarrhea, others cause constipation.
Each side effect is unique.
Almost universally chemotherapy causes fatigue.
And that is something that we are constantly battling.
But understand that a combination of drugs together and particular drugs can be very
different for different diseases and in different patients.
It's important when you begin a cancer treatment that you understand what drugs you're getting,
why you're getting those drugs and what to expect from those drugs and by that I mean
what kind of toxicities can one expect.
And it's important to begin your journey with as much education as possible so to know that
if I'm starting a drug what will my next three weeks be like?
Will I feel good for a few days?
What symptoms should I worry about in the next week?
Should I call if there's something out of the ordinary?
What should my expectations for work and family balance be like over the duration of my treatment?
All of that information up front can help.
It can be really tough to get that information in bite sized pieces in many cases.
Often people have been given a tough diagnosis and they start sort of this whirlwind of meet
our social worker, meet the nutritionist, let's start chemotherapy next week.
By understanding the side effects that you may experience when you're beginning your
chemotherapy journey it's very likely that you can reduce toxicity and side effects.
So the nurse that's treating you, the physician that's treating you, the physician assistant
or advanced practice nurse will all give you a lot of information about toxicities you
may or may not experience.
Things that we do routinely are we give drugs that decrease the likelihood of having an
allergic reaction to chemotherapy.
So sometimes you'll get steroids before you get a particular drug.
We have come so far in recent years in preventing nausea with good anti emetic agents.
And so you'll often be prescribed oral drugs to take at home after you receive chemotherapy
to prevent nausea.
So again you'll get a myriad of drugs to take at particular time in your treatment.
I think the most important thing that you can do is to understand what side-effects
you may experience and with that ask the question what can I do to prevent this?
And sort of that knowledge will help patients and caregivers through those first weeks of
chemotherapy in particular.
We have many patients who have minimal side effects and are able to continue working and
caring for their families and leading normal lives on chemotherapy.
And that's really our goal for all patients.
There are many things that patients and their family members and caregivers can do together
to decrease the side effects and toxicities of chemotherapy.
So I always say being as healthy as you can be every day is important.
So making sure that you're getting good nutrition, making sure that you're as active as you can
be.
A lot of that is listening to your body and there will be days that are good and you feel
like taking a walk and being outside, there are other days that you feel worn out.
It's important to be very in tune with your body.
Some side effects are expected.
But if the toxicities are extreme we need to know, physicians need to understand that
it may require that you're metabolizing drugs differently that doses need to be reduced,
delays need to be made and generally that does not compromise cancer therapy.
Being really in tune to side effects such as neuropathy so that's numbness and tingling
in your fingers and toes.
If you even start to develop that keeping those communication lines open with your physician
may cause changes in drug or decreases in dose that would be appropriate in your cancer
battle.
There are a lot of side effects that are more difficult to describe.
We try to make it easy for patients to describe how much pain they're having or if they're
having nausea or vomiting and those are question that we often ask directly.
But it's important to know that there are other side effects that are much more difficult
to quantify.
Problems concentrating, so that's a side effect of a lot of chemotherapy, some people sometimes
call chemo brain.
It's often you're under a lot of stress as a chemotherapy patient.
Medications can cause problems with attention and can cause drowsiness.
The myriad, the amount of information that you're taking in at one time can be overwhelming.
We need to hear about this because chemotherapy can cause some of those side effects.
Spacing chemotherapy or adding different drugs to combat those side effects may be an important
part of your treatment paradigm.
People worry about telling us about anxiety.
They say of course I have anxiety.
I've just gotten a difficult diagnosis.
Clearly that is a good coping mechanism and is appropriate, but sometimes anxiety can
get in the way of communication or of attending to symptoms that may alert us to other problems.
And so finding ways to cope with some of those side effects from becoming a cancer patient
from chemotherapy is certainly important.
In recent years we've made considerable progress in supportive care of our patients undergoing
chemotherapy.
We have drugs that can keep white blood cell counts up so that patients don't suffer from
significant infection that can be life threatening or can delay chemotherapy.
We now have evidence that there are particular drugs that can decrease cancer cocesia (ph.)
or weakness from cancer.
We know that that good nutrition is important.
We've certainly learned a lot about anti-nausea drugs.
And sure there are multiple avenues in which we've made progress.
Part of the progress in cancer has been refining our treatment strategies, but it also reflects
the advances we've made in supportive care over the past several decades.
In my practice we give information to our patients at the first visit.
But I ask them to do their homework too.
I send them to Cancer.Net.
They look at information, come back with questions and we can have dialogue over time about what
side effects they expect, implications for cancer care, treatment ideas over time.
And it can be extraordinarily helpful.
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